Cardiovascular Complications in HIV-Infected Individuals

HIV-infected patients face increased risk of myocardial infarction, as well as higher risk for ART-associated dyslipidemia and insulin resistance.

The “Dealing with Co-Morbidities of Chronic HIV: HPV-Related Cancers and Cardiovascular Disease” special session held at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) focused on the effects on disease treatment and prognosis of human papillomavirus (HPV) and cardiovascular disease in patients who are also infected with HIV.

Because HIV-infected individuals are at increased risk of cardiovascular disease, it is important that clinicians be aware that “traditional cardiovascular risk factors, and dyslipidemia and insulin resistance associated with antiretroviral medications, have been implicated in acute ischemic events, whereas chronic inflammation together with immune activation is associated with vascular dysfunction and atherothrombosis.”

The chairs of this special session noted that “prevention, diagnosis and treatment of CVD earlier are critical in HIV-infected individuals.”

In his presentation, “Cardiovascular complications in HIV infected individuals in developed and developing countries,” Mark Boyd MD, FRACP, of The Kirby Institute, University of New South Wales, Sydney, Australia, noted that HIV-infected individuals face a much higher risk of myocardial infarction (MI) than their HIV-negative counterparts, a risk that increases with age. He noted that the mean rate of MI per 1,000 person years is 11 for HIV-infected people vs. 7 for HIV-negative people.

Other highlight’s from Boyd’s presentation, according to this rapporteur’s session report, included:

  • Host risk factors such as dyslipidemia, smoking and insulin resistance were higher in those with HIV
  • The SMART study showed that treatment interruption resulted in 60% higher rates of CVD. Inflammatory makers (IL6) and coagulation markers (D-Dimer) were strongly associated with mortality risk.
  • The D.A.D. study revealed a higher risk of myocardial infarct with ART, including some PIs (not NNRTIs) were implicated as well as NRTIs abacavir and didanosine.
  • ART reduces but does not normalize inflammatory markers and affects lipids (as does HIV). Smoking cessation reduced risk of MI by 50% after 4 years.
  • The a large-scale MESA study in the general population aged 40-80 years, showed that not smoking, good diet, normal BMI and regular exercise resulted in a 6-fold lower risk of death.

Key takeaway points included “reducing modifiable risk factors in HIV patients was the most effective approach in low-, middle- and high-income countries,” and that ART was “the most effective means of reducing mortality in HIV.”

Watch a video of Dr. Boyd’s presentation here.